E-Ship Rising Registration Form
Thank you for taking the leap into E-Ship! We're excited that you're interested in E-Ship Rising!  The course starts April 4, 2024 - May 16, 2024 @ 4:30pm during Kids Zone @ Hazel Grove.  Pitch Event & Graduation will during the 3rd week of May.The course will be in-person. You must attend all sessions to be eligible for graduation. Have questions? Email our team at eshiprising@gmail.com.
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First Name *
Last Name *
Phone Number *
Email Address *
Date of Birth *
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Mailing Address *
Ethnicity *
Required
School Name ( Enter Grade Level or NA) *
Grade  *
Type of School *
Age *
Gender *
Shirt Size *
Parent/Emergency Contact Information: First & Last Name, Address & Phone Number *
Do you receive free or reduced lunch? *
Goals (What You Want To Accomplish) *
Profile Bio (Tell Us About You) *
Preferred Means of Communication
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Are you a returning member? *
Course Session *
If you do not have a business, what sector would you like to start your business in? *
Do you have reliable transportation? *
How did you hear about this program? *
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